From the Guidelines
Renal transplant failure can manifest through several key signs that patients and healthcare providers should monitor, including decreased urine output, fluid retention, elevated blood pressure, increased serum creatinine and blood urea nitrogen (BUN) levels, proteinuria, hematuria, fatigue, fever, pain or tenderness over the transplant site, and general malaise, as highlighted in a recent study 1. These signs are crucial for prompt intervention to prevent further deterioration of kidney function. Laboratory monitoring typically shows deteriorating kidney function with rising creatinine levels, which is often the earliest and most reliable indicator of rejection. Patients may also experience symptoms similar to those of chronic kidney disease, including nausea, vomiting, itching, and anemia.
Key Signs of Renal Transplant Failure
- Decreased urine output
- Fluid retention leading to swelling in the legs, ankles, or face
- Elevated blood pressure
- Increased serum creatinine and blood urea nitrogen (BUN) levels
- Proteinuria (protein in urine)
- Hematuria (blood in urine)
- Fatigue
- Fever
- Pain or tenderness over the transplant site
- General malaise Transplant rejection can occur acutely within days to weeks after transplantation or chronically over months to years. Acute rejection often presents with sudden onset of symptoms and rapid decline in kidney function, while chronic rejection typically shows gradual deterioration.
Importance of Regular Monitoring
Regular monitoring of kidney function through blood tests, urine analysis, and clinical evaluation is essential for all transplant recipients, as emphasized in a study published in the American Journal of Transplantation 2. Any suspicious symptoms should prompt immediate medical attention, as early intervention with immunosuppressive therapy adjustments or other treatments can potentially save the transplanted kidney. According to a recent study published in Kidney International 3, the management of a failing kidney allograft is complex and requires a multidisciplinary approach. The study highlights the importance of coordination of care and communication among teams to ensure adequate preparation and maximum availability of options for patients with failing allografts.
Management of Failing Allografts
- Coordination of care and communication among teams
- Multidisciplinary patient integrated care clinic (MDC)
- Ready access to multidisciplinary teams
- Seamless transition of care determined by the subsequent modality of kidney replacement therapy
- Partnership with social workers, dieticians, healthcare navigators, and emotional support staff
- Insurance policies and financial coverage
- Patient activation and psychological support during this difficult period. In summary, renal transplant failure can manifest through several key signs, and early detection is crucial for prompt intervention. Regular monitoring of kidney function and coordination of care are essential for all transplant recipients. The management of a failing kidney allograft requires a multidisciplinary approach, and further research is needed to address the significant gaps in knowledge in this area, as noted in a study published in Kidney International 3.
From the Research
Signs of Renal Transplant Rejection or Failure
- Rejection is a common cause of late graft dysfunction, as seen in biopsy studies 4
- A >30% increase in serum creatinine and/or development of > 1 g/day proteinuria can be an indication of renal transplant rejection or failure 4
- Late graft rejection, recurrent or de novo glomerulonephritis, and idiopathic chronic allograft nephropathy are possible causes of graft dysfunction 4
- Patients with a failed kidney transplant may start dialysis with more severe anaemia than patients entering dialysis for the first time 5
- Acute antibody-mediated rejection is an important cause of acute and chronic kidney allograft dysfunction and graft loss 6
- Infection is a major cause of morbidity and mortality in renal transplant recipients, and establishing a definite diagnosis of infection in a timely manner can be a challenge 7
- Patients with a failed kidney transplant have a significant increase in mortality compared with patients with a functioning graft or patients initiating dialysis for the first time 8
Clinical Indications of Rejection or Failure
- Increase in serum creatinine level 4, 6
- Development of proteinuria 4
- Anaemia 5
- Infection 7
- Graft dysfunction 4, 6, 8
Treatment and Management
- Pulse steroids, intravenous immunoglobulin, plasmapheresis, antithymocyte globulin, and rituximab may be used to treat late rejection 4
- Intensive plasmapheresis and intravenous immunoglobulin can be effective in treating antibody-mediated rejection 6
- Retransplantation is a feasible option that should be considered in patients with graft failure 8